Oncology| Volume 106, P119-124, August 2017

Download started.


Characterization of Late Recurrence After Radical Cystectomy in a Large Multicenter Cohort of Bladder Cancer Patients


      To investigate the characteristics and outcomes of late recurrence (LR) in patients with bladder cancer (BCa) treated with radical cystectomy (RC) and to identify clinicopathologic predictors of LR and postrecurrence survival.

      Materials and Methods

      This multicenter study included 1652 BCa patients. LR was defined as occurring more than 5 years after RC. Differences in postrecurrence overall survival according to the timing of disease recurrence and the location of recurrence were calculated using the log-rank test. A logistic regression model was used to identify predictors of LR, and Cox regression models were used to evaluate variables associated with postrecurrence overall survival (OS).


      Overall, 548 patients experienced disease recurrence. Of these, 67 patients (12.2%) experienced LR, with a median time to recurrence of 86 months (interquartile range 70.5-107.2). LR was more likely to be located in the urothelium (P = .005). On multivariable analysis, younger age (P = .008) and non–organ confined disease (P = .03) were found to be predictors of LR. Postrecurrence 5-year OS was worse in patients who experienced early recurrence compared with those with LR (12% vs 25%, P = .02) and in those with nonurothelial recurrence compared to those with disease recurrence in the remaining urothelium (12% vs 51%, P < .001). Older age (P < .001), non–organ confined disease at RC (P = .02), and nonurothelial recurrence site (P = .002) were independently associated with postrecurrence OS.


      LR after RC is an uncommon but non-negligible event that harbors unique characteristics. LR is associated with better OS compared to early recurrence. Our findings reinforce the need for lifelong follow-up of BCa patients after RC.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Babjuk M.
        • Burger M.
        • Zigeuner R.
        • et al.
        EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013.
        Eur Urol. 2013; 64: 639-653
        • Witjes J.A.
        • Compérat E.
        • Cowan N.C.
        • et al.
        EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines.
        Eur Urol. 2014; 65: 778-792
        • Shariat S.F.
        • Karakiewicz P.I.
        • Palapattu G.S.
        • et al.
        Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium.
        J Urol. 2006; 176 (discussion 2422): 2414-2422
        • Moschini M.
        • Karnes R.J.
        • Sharma V.
        • et al.
        Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: a 20-year single center experience.
        Eur J Surg Oncol. 2016; 42: 735-743
        • Sonpavde G.
        • Khan M.M.
        • Lerner S.P.
        • et al.
        Disease-free survival at 2 or 3 years correlates with 5-year overall survival of patients undergoing radical cystectomy for muscle invasive bladder cancer.
        J Urol. 2011; 185: 456-461
        • Rink M.
        • Lee D.J.
        • Kent M.
        • et al.
        Predictors of cancer-specific mortality after disease recurrence following radical cystectomy.
        BJU Int. 2013; 111: E30-E36
        • Solsona E.
        • Iborra I.
        • Rubio J.
        • Casanova J.
        • Dumont R.
        • Monrós J.L.
        Late oncological occurrences following radical cystectomy in patients with bladder cancer.
        Eur Urol. 2003; 43: 489-494
        • Linder B.J.
        • Boorjian S.A.
        • Hudolin T.
        • et al.
        Late recurrence after radical cystectomy: patterns, risk factors and outcomes.
        J Urol. 2014; 191: 1256-1261
        • Shariat S.F.
        • Svatek R.S.
        • Tilki D.
        • et al.
        International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy.
        BJU Int. 2010; 105: 1402-1412
        • Xylinas E.
        • Rink M.
        • Robinson B.D.
        • et al.
        Impact of histological variants on oncological outcomes of patients with urothelial carcinoma of the bladder treated with radical cystectomy.
        Eur J Cancer. 2013; 49: 1889-1897
        • Novara G.
        • Svatek R.S.
        • Karakiewicz P.I.
        • et al.
        Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients.
        J Urol. 2010; 183: 2165-2170
        • Rink M.
        • Fajkovic H.
        • Cha E.K.
        • et al.
        Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma.
        Eur Urol. 2012; 61: 854-855
        • Stein J.P.
        • Lieskovsky G.
        • Cote R.
        • et al.
        Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients.
        J Clin Oncol. 2001; 19: 666-675
        • Akkad T.
        • Gozzi C.
        • Deibl M.
        • et al.
        Tumor recurrence in the remnant urothelium of females undergoing radical cystectomy for transitional cell carcinoma of the bladder: long-term results from a single center.
        J Urol. 2006; 175 (discussion 1271): 1268-1271
        • Takayanagi A.
        • Masumori N.
        • Takahashi A.
        • Takagi Y.
        • Tsukamoto T.
        Upper urinary tract recurrence after radical cystectomy for bladder cancer: incidence and risk factors.
        Int J Urol. 2012; 19: 229-233
        • Sanderson K.M.
        • Cai J.
        • Miranda G.
        • Skinner D.G.
        • Stein J.P.
        Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1,069 patients with 10-year followup.
        J Urol. 2007; 177: 2088-2094
        • Chan Y.
        • Fisher P.
        • Tilki D.
        • Evans C.P.
        Urethral recurrence after cystectomy: current preventative measures, diagnosis and management.
        BJU Int. 2016; 117: 563-569
        • Crivelli J.J.
        • Xylinas E.
        • Kluth L.A.
        • Rieken M.
        • Rink M.
        • Shariat S.F.
        Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature.
        Eur Urol. 2014; 65: 742-754
        • Mitra A.P.
        • Quinn D.I.
        • Dorff T.B.
        • et al.
        Factors influencing post-recurrence survival in bladder cancer following radical cystectomy.
        BJU Int. 2012; 109: 846-854